2019

OUTLOOK

Industry Trends Report

Physical Medicine and Workers’ Comp

Welcome to the third annual Industry Trends Report for Physical Medicine in Workers’ Compensation. As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk has always been dedicated to understanding and advancing best practices. By sharing the most meaningful changes we’ve seen in the wider community over the last year and the insights into where PT for workers’ comp is going next, we hope to make an even larger impact on increasing patient-focused care and improving return-to-work success for patients, providers and employers alike.

272,095

TOTAL NETWORK PROVIDERS

100 %

U.S. BASED SERVICE MODEL

AVERAGE OF 4 HOURS TO SCHEDULING

MedRisk by the Numbers

 

MedRisk is the largest specialty managed care organization in the workers’ compensation industry that is dedicated to physical rehabilitation.

97.7 %

OF NETWORK PROVIDERS AGREE WITH OUR CLINICAL RECOMMENDATIONS

559,783

INJURED WORKERS TREATED IN 2019

2.6 DAYS TO INITIAL EVALUATION

98.1 %

PATIENT SATISFACTION

The Cost-of-Care Workers’ Comp vs. Group Health

The total cost of physical therapy in workers’ compensation is almost three times higher than in group health. But it’s not just the unit cost that’s driving these numbers, it’s the quantity of care (utilization). Workers’ comp patients are not only 45% more likely to receive PT but they receive 50% more visits and 20% more modalities per visit compared to group health patients according to recent research by NCCI.

While there is a modest unit price differential (105% more for workers’ comp than group health), the utilization of physical medicine in workers’ comp is 268% that of group health, making up the vast majority of the total cost differential.

Physical rehabilitation is a critical element of restoring functionality after a work-related injury and ensuring safe return to work but in an industry without cost-sharing mechanisms or co-pays, it is just as critical that the quality care is both effective and efficient. To tackle the cost-of-care challenge, therefore, it is critical to look at not just unit cost but the volume of service.

%

More visits per patient than Group Health

%

More likely to receive PT than Group Health

%

More modalities per visit than Group Health

TRENDING AT MEDRISK

Post-Surgical PT Cases Down

The conservative care movement continues to make an impact throughout the industry. Changes such as Ohio’s PT-first mandate and tighter utilization review controls in California have significantly decreased surgeries and, consequently, post-surgical PT. As such, MedRisk has seen post-surgical cases drop by 26% in the last 5 years. Could this be an early sign that PT is gaining traction as a preventative treatment strategy?

TELEREHABILITATION

  • Patient Perspective: Sometimes telerehabilitation can be a necessity for faster return to work and not “just” a convenience. A traveling nurse practitioner who conducts in-home patient assessments for a large group health insurance company discovered how telerehab could enable her to meet treatment expectations and continue to work—something that wouldn’t have been possible otherwise.
  • Physical Therapist Perspective: When Jill Carnahan, PT, DPT, began working on telerehab cases at MedRisk, she was skeptical. “The more patients I’ve treated, the more I realized the power of voice. It requires focus, communication and collaboration, but when the patient gets it on their own, you know they really get it.”

PATIENT EDUCATION

<ul>
<li><a href=”https://www.medrisknet.com//statistics-spotlight-physical-therapy-reduces-costs/” target=”_blank” rel=”noopener”>Physical therapy as first-line treatment can improve patient outcomes</a>, but what about a consultation with a physical therapist? Can a simple conversation in advance of treatment affect outcomes? Research says yes.</li>
<li><a href=”https://www.medrisknet.com//study-summary-odds-opioid-prescription-reduced-physical-therapy-consult/” target=”_blank” rel=”noopener”>A 2018 study</a> from the University of Utah found that a discussion between patient and provider about the severity of pain and prognosis can reduce the chance of opioid prescription by up to 65%.</li>
<li><a href=”https://www.medrisknet.com//3-ways-physical-therapy-consultation-benefits-the-injured-worker/” target=”_blank” rel=”noopener”>A PT consult through MedRisk</a> addresses catastrophic thinking and other negative factors following an occupational injury. For example, a patient may have a standard diagnosis but may express a fear of reinjury during a consultation. This information can be used to inform treatment strategies and prevent delayed recovery.</li>

PIONEERING MANAGED PT

In 1994, MedRisk offered the Workers’ Comp community the first specialty managed care program for PT services. Since then, we’ve continued to pioneer new programs that improve, enhance or further our understanding of faster, better recovery.

Legislative Recap

 

MedRisk gathers the latest legislative and regulatory developments and challenges each quarter. Here is a full summary of significant movements in 2021 and the implications for 2022.

In January, the Centers for Medicare and Medicaid Services (CMS) launched a National Coverage Analysis to determine whether Medicare should pay for acupuncture treatment for chronic low back pain. CMS cited its motivations as a push from the US Department of Human and Health Services to deliver evidence-based, non-drug treatment solutions for chronic pain in response to the opioid crisis.

In July, CMS published a proposed Decision Memo approving Medicare coverage for Acupuncture. Coverage for acupuncture will be limited to clinical trials for treating low back pain. CMS will respond to public comments in the future.

New York Governor Andrew Cuomo signed into law an omnibus budget bill containing authorization for providers of acupuncture to treat injured workers within the WC system, provided the patient has a referral from a physician or nurse practitioner. Physical and occupational therapists are among the clinicians that are permitted to perform acupuncture if they are certified to perform these services. The Workers’ Compensation Board, which supported this expansion, has proposed a regulation (12 NYCRR 323.1) and the comment period ended August 18, 2019.

When the regulation is adopted by the WCB, New York will join a handful of other states in authorizing payment for acupuncture under workers’ compensation when the services are deemed medically necessary. Most of the jurisdictions that affirmatively permit acupuncture for WC claimants require a referral from a treating physician.

North Carolina recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

Virginia recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

Arizona recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

In January 2019, California became the first state to adopt a fee schedule using 32 distinct regional rates for MSA-based localities, based on Medicare Geographic Practice Cost Index (GPCI), which is now in the process of a six-year phase-in. Since many jurisdictions currently use other Medicare payment rules, and since use of dominant Medicare regional payment methodology offers both improved health care access to claimants and operational economies to WC agencies, it is possible that other states will follow suit.

The primary beneficiaries of the GPCI based regional fee schedule are providers in some of the higher-cost urban areas, who would see regulatory rate increases. Payers would be required to modify their bill review systems in order to properly track regulatory rates and providers’ treatment locations.

Senate Bill 537 has been signed into law by Governor Newsom. The law requires networks to give a standardized disclosure form to their payer clients if network provider reimbursements are less than 80 percent of the Official Medical Fee Schedule rates.

The Division of Workers’ Compensation is given the task of developing the provider reimbursement disclosure form required by this provision, which becomes effective July 1, 2021. Medical provider networks will also be required to post a roster of their participating providers online and provide the DIR with the authority to investigate complaints, conduct random reviews and take enforcement action against medical provider networks that fail to comply with roster postings.

Arkansas recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

Colorado recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

Kentucky recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

Nebraska recently enacted legislation to join the PT Compact, an interstate reciprocal agreement permitting physical therapists licensed in one state to practice in another. The PT Compact makes it easier for physical therapists to treat across jurisdictions removing the administrative barriers to multi-jurisdictional practice. You can stay up to date on which states have enacted legislation or are in the process of enacting legislation by visiting the PT Compact website.

Nevada enacted two laws that impose new regulatory requirements on workers’ compensation managed care. Senate Bill 365 requires all “health carriers,” including workers’ compensation payers, to explicitly state contract rights and obligations in provider agreement and to maintain a website listing all customers granted network access via the provider agreement. The new law is due to take effect on January 1, 2020, after the Division of Industrial Relations has adopted implementing regulations.

Nevada also enacted Senate Bill 381, which permits a WC insurer to limit employee choice of physician or chiropractor to those listed on its provider panel, but only if the panel contains, by discipline or medical specialty, at least twelve providers or, if there are fewer than twelve authorized by the Division, all of the members of the discipline or specialty.

Neither of the new statutes have much impact on MedRisk workflows for operations in Nevada. MedRisk provider agreements and operations already conform to the “best practices” standards of SB 365. Further, the increased network access standards of SB 381 relate only to physicians and chiropractors.

Research & Insights

11 Key Recommendations for Best-Practice Musculoskeletal Treatment

In a recent article published in the British Journal of Sports Medicine, a multidisciplinary research team identified 11 clinical practice guideline (CPG) recommendations for treating adult musculoskeletal pain, all of which have been historically supported by the MedRisk Platinum Grade Program for Physical Medicine. The recommendations are the product of a systemic review of 44 CPGs addressing spinal pain, hip/knee pain and shoulder pain. The authors contend that practice aligned with these guidelines results in “better outcomes and lower costs.

Patient Satisfaction Low for WC vs Group

A retrospective investigation performed at the Department of Orthopedic Surgery and Rehabilitation at the University of Iowa Hospitals and Clinics found workers’ compensation status was independently associated with dissatisfaction on patient surveys. When asked about their care, workers’ compensation patients rated their overall health lower, were more likely to give lower ratings to providers, and were “significantly less likely to recommend the practice to other patients” than other primary payer groups. The researchers concluded that “Workers’ Compensation status is a non-modifiable independent predictor of dissatisfaction with health care” and called for further research.

Patient education, however, has been shown to improve patient satisfaction. Could quality support and expectation setting through PT consults, patient advocacy reminders and other patient education initiatives change this non-modifiable predicator?

Myths and Truths About Psychosocial Factors in Low Back Pain

A recent article in the British Journal of Sports Medicine explored some common myths and truths surrounding the impact psychosocial factors have on treating low back pain, covering mental health disorder assessments, the biological connection and the danger of the “failed patient” label. The authors also issued a call to action to clinicians to systemically explore psychosocial factors, upskill to better understand the issues, and begin to treat psychosocial barriers as a standard part of treating low back pain.

Study Links Physical Therapy to Better Recovery for Knee Replacement Surgery Patients

Total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure in the United States. However, some studies have indicated that rehabilitation following knee replacement surgery may not be needed. Setting out to examine this hypothesis, a team of researchers from the University of Colorado School of Medicine recently conducted a study with the objectives of (1) investigating whether PT utilization is associated with functional improvements for TKA patients in home health care settings and (2) exploring which factors are related to PT utilization.

The bottom line? According to lead researcher Dr. Jason Falvey, the risks of not providing the appropriate level of care post-surgery may result in higher overall healthcare costs in the long term. More research is needed to develop specific evidence-based treatment strategies for TKA patients, but based on these findings, telerehab, which allows post-surgery treatment to be done in the home, may be a useful tool in promoting patient engagement and utilization for better outcomes after surgery.

Could Exercise-Based Interventions Be the Answer to Preventing Occupational Low Back Pain?

Non-specific low back pain (LBP) continues to pose a significant public health risk in the United States and other industrialized countries, where lifetime prevalence is 60-70% and 37% of global LBP cases are believed to be work-related. A review of 28 published articles has determined which employer interventions are most effective at preventing LBP on the job. The study team found exercise alone or together with education was the only approach that was consistently effective in the prevention of LBP across the body of research. Notably, education in combination with exercise was found to be more effective than education alone, bolstering the case for a multidimensional approach to LBP prevention in the workplace.

Prior Trends Reports

2023

2022

2021

2019

2018

2017